Health Seeking Behaviour Among Care-givers for Children Under-five Years in Zambia - a Comparative Analysis of 2015 and 2018 Malaria Indicator Survey.

Fever is one the most reported out-patient complaint and predictor for malaria illness in regions were the disease is endemic. The capacity for care-givers of febrile children under 5 years to recognise fever early is very important in the control of malaria. There has been a decline in health seeking-behaviour among care-givers of febrile children under-5 years in Zambia, from 36% in 2015 to 26% in 2018 as reported by the Malaria Indicator Surveys (MIS) in Zambia. The study identified and compared the proportion and factors associated with health-seeking behaviour among care-givers of febrile children suspected to have malaria between the 2015 and 2018 MIS in Zambia. Methods: This was a comparative cross-sectional analysis of the 2015 and 2018 MIS data in Zambia. Analysis of factors associated with health-seeking behaviour among care-givers of children was undertaken using logistic regression with STATA software version 16 SE.Of the total 4272 respondents, 67% were children in the 2015 MIS, 50.6% were males and 58.5% were less-than 24 months old. At adjusted logistic regression in the 2015 MIS; age less-than 12 months compared to 12-59 months was not associated with health-seeking behaviour (AOR 1.6;95% CI 0.8 to 3.1; p=0.117). Middle wealth quintiles compared to children in other quintiles were more likely to seek prompt health-care after onset of fever, (OR=3.08; CI 95% 1.26 - 7.56; p 0.014). While in 2018, children less 12 months compared to 12 months-59 months (OR 0.58; 95% CI 0.24 -1.39; p=0.220) was not associated with health-seeking behaviour. Residence: rural compared to urban (OR= 5.47; 95% CI 1.06 - 28.05; p<0.05) was associated with care-givers’ promptness to seek health-care for children under 5 years. Conclusion: Early health-seeking behaviour among febrile children was associated with wealth status and rural residence in both the 2015 and 2018 surveys. Furthermore, there was a significant difference in health-seeking behaviour between the two years. It is critical that strengthened socio behavior change communication is on the importance of prompt health-seeking among care-givers of children under 5 years. Provision of health services as close to the family as possible is important as it enhances health-seeking as time taken and distance health facilities are reduced.